SummaryBackgroundEfforts to establish the 2015 baseline and monitor early implementation of the UN Sustainable Development Goals (SDGs) highlight both great potential for and threats to improving health by 2030. To fully deliver on the SDG aim of “leaving no one behind”, it is increasingly important to examine the health-related SDGs beyond national-level estimates. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017), we measured progress on 41 of 52 health-related SDG indicators and estimated the health-related SDG index for 195 countries and territories for the period 1990–2017, projected indicators to 2030, and analysed global attainment.MethodsWe measured progress on 41 health-related SDG indicators from 1990 to 2017, an increase of four indicators since GBD 2016 (new indicators were health worker density, sexual violence by non-intimate partners, population census status, and prevalence of physical and sexual violence [reported separately]). We also improved the measurement of several previously reported indicators. We constructed national-level estimates and, for a subset of health-related SDGs, examined indicator-level differences by sex and Socio-demographic Index (SDI) quintile. We also did subnational assessments of performance for selected countries. To construct the health-related SDG index, we transformed the value for each indicator on a scale of 0–100, with 0 as the 2·5th percentile and 100 as the 97·5th percentile of 1000 draws calculated from 1990 to 2030, and took the geometric mean of the scaled indicators by target. To generate projections through 2030, we used a forecasting framework that drew estimates from the broader GBD study and used weighted averages of indicator-specific and country-specific annualised rates of change from 1990 to 2017 to inform future estimates. We assessed attainment of indicators with defined targets in two ways: first, using mean values projected for 2030, and then using the probability of attainment in 2030 calculated from 1000 draws. We also did a global attainment analysis of the feasibility of attaining SDG targets on the basis of past trends. Using 2015 global averages of indicators with defined SDG targets, we calculated the global annualised rates of change required from 2015 to 2030 to meet these targets, and then identified in what percentiles the required global annualised rates of change fell in the distribution of country-level rates of change from 1990 to 2015. We took the mean of these global percentile values across indicators and applied the past rate of change at this mean global percentile to all health-related SDG indicators, irrespective of target definition, to estimate the equivalent 2030 global average value and percentage change from 2015 to 2030 for each indicator.FindingsThe global median health-related SDG index in 2017 was 59·4 (IQR 35·4–67·3), ranging from a low of 11·6 (95% uncertainty interval 9·6–14·0) to a high of 84·9 (83·1–86·7). SDG index values in countries assessed at the subnational level...

Cardiovascular diseases (CVDs) are the leading cause of disease burden globally, disproportionately affecting low and middle-income countries. The continued scarcity of literature on CVDs burden in Nepal has thwarted efforts to develop population-specific prevention and management strategies. This article reports the burden of CVDs in Nepal including, prevalence, incidence, and disability basis as well as trends over the past two decades by age and gender. We used the Institute of Health Metrics and Evaluation’s Global Burden of Diseases database on cardiovascular disease from Nepal to describe the most recent data available (2017) and trends by age, gender and year from 1990 to 2017. Data are presented as percentages or as rates per 100,000 population. In 2017, CVDs contributed to 26·9% of total deaths and 12·8% of total DALYs in Nepal. Ischemic heart disease was the predominant CVDs, contributing 16·4% to total deaths and 7·5% to total DALYs. Cardiovascular disease incidence and mortality rates have increased from 1990 to 2017, with the burden greater among males and among older age groups. The leading risk factors for CVDs were determined to be high systolic blood pressure, high low density lipoprotein cholesterol, smoking, air pollution, a diet low in whole grains, and a diet low in fruit. CVDs are a major public health problem in Nepal contributing to the high DALYs with unacceptable numbers of premature deaths. There is an urgent need to address the increasing burden of CVDs and their associated risk factors, particularly high blood pressure, body mass index and unhealthy diet.

Background Cardiovascular diseases (CVDs) are the leading cause of deaths and disability in Nepal. Health systems can improve CVD health outcomes even in resource-limited settings by directing efforts to meet critical system gaps. This study aimed to identify Nepal’s health systems gaps to prevent and manage CVDs. Methods We formed a task force composed of the government and non-government representatives and assessed health system performance across six building blocks: governance, service delivery, human resources, medical products, information system, and financing in terms of equity, access, coverage, efficiency, quality, safety and sustainability. We reviewed 125 national health policies, plans, strategies, guidelines, reports and websites and conducted 52 key informant interviews. We grouped notes from desk review and transcripts’ codes into equity, access, coverage, efficiency, quality, safety and sustainability of the health system. Results National health insurance covers less than 10% of the population; and more than 50% of the health spending is out of pocket. The efficiency of CVDs prevention and management programs in Nepal is affected by the shortage of human resources, weak monitoring and supervision, and inadequate engagement of stakeholders. There are policies and strategies in place to ensure quality of care, however their implementation and supervision is weak. The total budget on health has been increasing over the past five years. However, the funding on CVDs is negligible. Conclusion Governments at the federal, provincial and local levels should prioritize CVDs care and partner with non-government organizations to improve preventive and curative CVDs services.

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Background: Neonatal period is a period from birth to under 28 days of life. The common causes of mortality and morbidity in our region are preventable, among which neonatal sepsis is the commonest one. Most of the deaths occur within 7 days of life. Objectives: To study the clinical profile, pattern of diseases, causes of morbidity and mortality amongst newborns. Materials and methods: A hospital based descriptive study was done among total 967 newborns including both inborn and out born admitted in NICU, NGMC from January 2016 to December 2016. Age, sex, gestational age, diagnosis at admission, outcome of admitted th newborns were the main variables under study. Data was entered in Excel and analyzed using SPSS 20th version. Data were presented through pie, bar graph and table with frequency and percentage. Results: Male were predominant in the study (65%). One third of the admitted newborns were preterms. Half of the admitted newborns were admitted on their first day of life. Neonatal sepsis was the most common cause of admission. Deaths occured in 7.4%of total babies. Seventy-six percent got improved after treatment. Only 2.8% were referred to higher center. Conclusions: Most of the neonates got admitted in first day of life with commonest cause being neonatal sepsis. Recovery rate was satisfactory. To reduce the mortality and morbidity of neonates, we need to increase awareness level in general population and proper aseptic practices in medical practitioners.

Objectives: Oral submucous fibrosis (OSMF) is an insidious precancerous disease mostly seen in the Southeast Asia. This paper aims to study on clinical profile of patients with OSMFMaterial and Methods: This cross sectional study was done in department of ENT and HNS, Nepalgunj Medical College and Teaching Hospital. In outpatient department patients with OSMF were ask to fill up a questionnaire that included identification of patient, occupation, their symptoms and habit of taking betel quid or paan, gutkha, etc. Oral cavity was examined and lesion along with its extent and severity was noted. Intra lesional steroid and antioxidant and physiotherapy were main stay of treatment.Results: There were total 136 patients (98 male and 38 female) from 15th Dec 2013 to 15th Jan 2015. Age of patient ranged from 16 years to 53 years and average being 25.6years. Most common preparation taken was gutkha 131(96.3%) followed by betel nut, betel quid etc. Only 24(17.6%) were taking these preparations for less than 1 year. Common presenting complaints were difficulty in opening mouth followed by burning sensation and dryness of mouth. Clinically, the extent of fibrous band was found to be more commonly involving soft palate, pillars and buccal mucosa. Isolated involvement of different region of oropharynx or oral cavity was less common. Correlation of grade of trismus and average duration of taking these different preparations was highly significant. (p=0.008)Conclusions: Oral submucous fibrosis is commonly associated with intake of gutkha having dose dependent relationship with trismus. Further studies are required why only a small fraction of those using betel quid develop the disease.

Background Cardiovascular diseases (CVDs) are the leading cause of death and disease burden globally, disproportionately affecting low and middle-income countries. The continued scarcity of literature on CVDs burden in Nepal has thwarted efforts to develop population-specific prevention and management strategies. This article reports the burden of CVDs in Nepal including, prevalence, incidence, and disability basis as well as trends over the past two decades by age and gender. The findings from this study provide a base for public health priorities and for creating evidence-informed policies.Methods We used the Institute of Health Metrics and Evaluation (IHME)’s Global Burden of Diseases (GBD) database on cardiovascular disease mortality rates, prevalence, incidence, disability-adjusted life-years (DALYs), years of life lost (YLLs) and years lived with disability (YLDs) from Nepal to describe the most recent data available (2017) and trends by age, gender and year from 1990 to 2017. Tables, graphs and histograms are used to compare patterns and trends across all metrics. Data are presented as percentages or as rates per 100,000 population.Results In 2017, CVDs contributed to 26·9% of total deaths and 12·8% of total DALYs in Nepal. Ischemic heart disease and stroke were the predominant CVDs, contributing 16·4% and 7·5% to total deaths and 7·5% and 3·5% to total DALYs, respectively. Cardiovascular disease incidence and mortality rates have increased from 1990 to 2017, with the burden greater among males and among older age groups. The leading risk factors for CVDs were determined to be high systolic blood pressure, high low density lipoprotein (LDL) cholesterol, smoking, air pollution, a diet low in whole grains, and a diet low in fruit.Conclusion CVDs are a major public health problem in Nepal contributing to the high DALYs with unacceptable numbers of premature deaths. There is an urgent need to address the increasing burden of CVDs and their associated risk factors, particularly high blood pressure, body mass index (BMI) and unhealthy diet.